timolol

In its by mouth or oral form, it is used:

• to treat high blood pressure
• to prevent heart attacks
• to prevent migraine headaches{{cite book| vauthors = Marcus DA, Bain PA |title=Effective Migraine Treatment in Pregnant and Lactating Women: A Practical Guide |url= https://books.google.com/books?id=Z5YWpjj89NEC&pg=PA141 |access-date=14 November 2010 |date=27 February 2009 |publisher=シュプリンガー・ジャパン株式会社 |isbn=978-1-60327-438-8 |pages=141– |url-status=live |archive-url=https://web.archive.org/web/20171105201118/https://books.google.com/books?id=Z5YWpjj89NEC&pg=PA141 |archive-date=5 November 2017 }}

The combination of timolol and the alpha-1 blocker prazosin has sedative effects.{{cite journal | vauthors = Atkin T, Comai S, Gobbi G|author3-link=Gabriella Gobbi | title = Drugs for Insomnia beyond Benzodiazepines: Pharmacology, Clinical Applications, and Discovery | journal = Pharmacol Rev | volume = 70 | issue = 2 | pages = 197–245 | date = April 2018 | pmid = 29487083 | doi = 10.1124/pr.117.014381 |s2cid=3578916 | url = | doi-access = free }}

In its eye drop form it is used to treat open-angle and, occasionally, secondary glaucoma.{{cite web | title=Timolol Ophthalmic | website=MedlinePlus | date=15 April 2017 | url=https://medlineplus.gov/druginfo/meds/a682043.html | access-date=31 December 2019}} The mechanism of action of timolol is probably the reduction of the formation of aqueous humor in the ciliary body in the eye. It was the first beta blocker approved for topical use in treatment of glaucoma in the United States (1978).{{cite journal | vauthors = Sambhara D, Aref AA | title = Glaucoma management: relative value and place in therapy of available drug treatments | journal = Therapeutic Advances in Chronic Disease | volume = 5 | issue = 1 | pages = 30–43 | date = January 2014 | pmid = 24381726 | pmc = 3871276 | doi = 10.1177/2040622313511286 }} When used by itself, it depresses intraocular pressure (IOP) 18–34% below baseline within first few treatments. However, there are short-term escape and long-term drift effects in some people. That is, tolerance develops. It may reduce the extent of the daytime IOP curve up to 50%. The IOP is higher during sleep. Efficacy of timolol in lowering IOP during the sleep period may be limited.{{cite journal | vauthors = Liu JH, Kripke DF, Weinreb RN | title = Comparison of the nighttime effects of once-daily timolol and latanoprost on intraocular pressure | journal = American Journal of Ophthalmology | volume = 138 | issue = 3 | pages = 389–95 | date = September 2004 | pmid = 15364220 | doi = 10.1016/j.ajo.2004.04.022 }}{{cite journal | vauthors = Liu JH, Medeiros FA, Slight JR, Weinreb RN | title = Comparing diurnal and nocturnal effects of brinzolamide and timolol on intraocular pressure in patients receiving latanoprost monotherapy | journal = Ophthalmology | volume = 116 | issue = 3 | pages = 449–54 | date = March 2009 | pmid = 19157559 | doi = 10.1016/j.ophtha.2008.09.054 }}{{cite journal | vauthors = Liu JH, Slight JR, Vittitow JL, Scassellati Sforzolini B, Weinreb RN | title = Efficacy of Latanoprostene Bunod 0.024% Compared With Timolol 0.5% in Lowering Intraocular Pressure Over 24 Hours | journal = American Journal of Ophthalmology | volume = 169 | pages = 249–257 | date = September 2016 | pmid = 27457257 | doi = 10.1016/j.ajo.2016.04.019 | doi-access = free }} It is a 5–10× more potent beta blocker than propranolol. Timolol is light-sensitive; it is usually preserved with 0.01% benzalkonium chloride (BAC), but also comes BAC-free. It can also be used in combination with pilocarpine, carbonic anhydrase inhibitors{{cite journal | vauthors = Strohmaier K, Snyder E, Adamsons I | title = A multicenter study comparing dorzolamide and pilocarpine as adjunctive therapy to timolol: patient preference and impact on daily life | journal = Journal of the American Optometric Association | volume = 69 | issue = 7 | pages = 441–51 | date = July 1998 | pmid = 9697378 }} or prostaglandin analogs.{{cite web | title=Ganfort 0.3 mg/ml + 5 mg/ml eye drops, solution - Summary of Product Characteristics (SmPC) | website=(emc) | url=https://www.medicines.org.uk/emc/product/204/smpc | date=20 February 2020 | access-date=1 March 2020}}

A Cochrane review compared the effect of timolol versus brimonidine in slowing the progression of open angle glaucoma in adults but found insufficient evidence to come to conclusions.{{cite journal | vauthors = Sena DF, Lindsley K | title = Neuroprotection for treatment of glaucoma in adults | journal = The Cochrane Database of Systematic Reviews | volume = 1 | issue = 1 | pages = CD006539 | date = January 2017 | pmid = 28122126 | pmc = 5370094 | doi = 10.1002/14651858.CD006539.pub4 }}

In its gel form it is used on the skin to treat infantile hemangiomas.{{cite journal | vauthors = Novoa M, Baselga E, Beltran S, Giraldo L, Shahbaz A, Pardo-Hernandez H, Arevalo-Rodriguez I | title = Interventions for infantile haemangiomas of the skin | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | pages = CD006545 | date = April 2018 | issue = 4 | pmid = 29667726 | pmc = 6513200 | doi = 10.1002/14651858.CD006545.pub3 }}

The medication should not be taken by individuals with:{{cite web | title=Timolol Maleate tablet | website=DailyMed | date=17 August 2006 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=57c62928-63d8-4505-9b9e-c085a3a12c95 | access-date=1 December 2019}}

• An allergy to timolol or any other beta-blockers
• Asthma or severe chronic obstructive bronchitis
• A slow heart rate (bradycardia), or a heart block
• Heart failure{{Cite web|url=https://www.hpra.ie/img/uploaded/swedocuments/PIL-2183359-20032017174542-636256287433370000.pdf|title=Package leaflet: Information for the user Timolol|website=hpra.ie|access-date=15 August 2018|archive-date=16 August 2018|archive-url=https://web.archive.org/web/20180816025712/https://www.hpra.ie/img/uploaded/swedocuments/PIL-2183359-20032017174542-636256287433370000.pdf|url-status=dead}}

The most serious possible side effects include cardiac arrhythmias and severe bronchospasms. Timolol can also lead to fainting, congestive heart failure, depression, confusion, worsening of Raynaud's syndrome and impotence.

Side effects when given in the eye include: burning sensation, eye redness, superficial punctate keratopathy, corneal numbness.{{cite web | title=Betimol- timolol solution | website=DailyMed | date=18 March 2010 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=00f62dd1-dad2-4892-8a5d-21e5e54509ce | access-date=1 December 2019}}

It is available in tablet and liquid formulations.

For ophthalmic use, timolol is also available combined:

• with carbonic anhydrase inhibitors:
• timolol and brinzolamide
• timolol and dorzolamide
• with α₂ agonists:
• timolol and brimonidine
• with prostaglandin analogs:
• timolol and latanoprost
• timolol and travoprost

Timolol is sold under many brand names worldwide.{{cite web|title=Timolol|url=https://www.drugs.com/international/timolol.html|publisher=Drugs.com|access-date=28 December 2016|url-status=live|archive-url=https://web.archive.org/web/20160307081135/http://www.drugs.com/international/timolol.html|archive-date=7 March 2016}} Timolol eye drops are sold under the brand names Timoptic and Istalol among others.{{cite web |url=https://www.drugs.com/availability/generic-istalol.html |publisher=Drugs.com |title=Generic Istalol Availability |access-date=20 June 2019}}{{cite web | title=Istalol | publisher=Drugs.com | date=1 August 2018 | url=https://www.drugs.com/pro/istalol.html | access-date=19 July 2019}}

{{Reflist}}

• {{cite web | title=Timolol Ophthalmic | website=MedlinePlus | url=https://medlineplus.gov/druginfo/meds/a682043.html }}

{{Beta blockers}}

{{Antiglaucoma preparations and miotics}}

{{Adrenergic receptor modulators}}

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Category:4-Morpholinyl compounds

Category:Beta blockers

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